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Perioper Med (Lond). 2017 Apr 13;6:7. doi: 10.1186/s13741-017-0063-6. eCollection 2017.

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) Joint Consensus Statement on Optimal Analgesia within an Enhanced Recovery Pathway for Colorectal Surgery: Part 2-From PACU to the Transition Home.

Author information

1
Department of Anesthesiology, Virginia Commonwealth University Health System, 1200 East Broad Street, P.O. Box 980695, Richmond, Virginia 23298-0695 USA.
2
University College London, London, UK.
3
CIPHER (Center for Innovation in Perioperative Health, Education, and Research), Vanderbilt University Medical Center, TN, USA.
4
Department of Anesthesiology, Vanderbilt University School of Medicine, 2301VUH,, Nashville, TN 37232 USA.
5
Department of Anesthesiology & Pain Medicine, Harborview Integrated Pain Care Program, University of Washington, Seattle, WA USA.
6
Department of Anesthesiology, Medical Student Education, Division of Regional Division, Duke University Medical Center, Durham, UK.
7
Department of Surgery, Division of Advanced Oncologic and GI Surgery, Duke University Medical Center, Durham, UK.
8
Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD USA.
9
Department of Anesthesiology, Stony Brook University School of Medicine, Stony Brook, USA.
10
University College London Hospitals National Institute of Health Research Biomedical Research Centre, London, UK.
11
Department of Anesthesiology, Vanderbilt University, TN, USA.
12
Division of General, Vascular and Transplant Anesthesia, Duke University Medical Center, Durham, UK.
#
Contributed equally

Abstract

BACKGROUND:

Within an enhanced recovery pathway (ERP), the approach to treating pain should be multifaceted and the goal should be to deliver "optimal analgesia", which we define in this paper as a technique that optimizes patient comfort and facilitates functional recovery with the fewest medication side effects.

METHODS:

With input from a multidisciplinary, international group of experts and through a structured review of the literature and use of a modified Delphi method, we achieved consensus surrounding the topic of optimal analgesia in the perioperative period for colorectal surgery patients.

DISCUSSION:

As a part of the first Perioperative Quality Improvement (POQI) workgroup meeting, we sought to develop a consensus document describing a comprehensive, yet rational and practical, approach for developing an evidence-based plan for achieving optimal analgesia, specifically for a colorectal surgery within an ERP. The goal was twofold: (a) that application of this process would lead to improved patient outcomes and (b) that investigation of the questions raised would identify knowledge gaps to aid the direction for research into analgesia within ERPs in the years to come. This document details the evidence for a wide range of analgesic components, with particular focus on care in the post-anesthesia care unit, general care ward, and transition to home after discharge. The preoperative and operative consensus statement for analgesia was covered in Part 1 of this paper. The overall conclusion is that the combination of analgesic techniques employed in the perioperative period is not important as long as it is effective in delivering the goal of "optimal analgesia" as set forth in this document.

KEYWORDS:

Analgesia; Colorectal surgery; Enhanced recovery pathway; Multimodal; Non-opioid adjuncts; Optimal analgesia; Outcomes; Pain management; Post-discharge; Postoperative; Quality

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